Healthcare Provider Details

I. General information

NPI: 1275696742
Provider Name (Legal Business Name): NORTHWEST MONTANA SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 BURNS WAY
KALISPELL MT
59901-3109
US

IV. Provider business mailing address

1273 BURNS WAY
KALISPELL MT
59901-3109
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-5000
  • Fax: 406-752-8220
Mailing address:
  • Phone: 406-752-5000
  • Fax: 406-752-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN G MILHEIM
Title or Position: GROUP EXECUTIVE
Credential: M.D.
Phone: 406-752-5000